Provider Demographics
NPI:1063289247
Name:AZIMI, YEGANEH (PAC)
Entity type:Individual
Prefix:
First Name:YEGANEH
Middle Name:
Last Name:AZIMI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 E 148TH ST S
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-4407
Mailing Address - Country:US
Mailing Address - Phone:918-852-7056
Mailing Address - Fax:
Practice Address - Street 1:1145 S UTICA AVE STE 365
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4004
Practice Address - Country:US
Practice Address - Phone:918-728-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5141207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services